| NPI | 1972051787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 8068) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 8068) |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2022-03-24 |